Organization Active NPI

Dare Behavioral Health and Wellness Clinic PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Mesa, AZ
National Provider Identifier
1467341883
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
DARE BEHAVIORAL HEALTH AND WELLNESS CLINIC PLLC
Practice address
5235 E Southern Ave Ste 106-145
Mesa, AZ 85206-3626
Phone
(480) 501-0511
NPI assigned
Jul 1, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Emmanuel OluwadareNPI 1902698277
Title
Owner
Phone
(480) 501-0511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

5235 E Southern Ave Ste 106-145
Mesa, AZ 85206-3626

Mailing address

5235 E Southern Ave Ste 106-145
Mesa, AZ 85206-3626

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250929003870 AZ Part B Supplier - Clinic/Group Practice 6800392887 Receives reassigned benefits from 1 practitioner
Practice locations: Mesa, AZ

National Provider Directory

National Provider Directory

Locations

5235 E Southern Ave
Ste 106145
Mesa, AZ 85206
Phone (480) 501-0511

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751328000000",
    "number": "1467341883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5235 E SOUTHERN AVE STE 106-145",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5235 E SOUTHERN AVE STE 106-145",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063626",
            "telephone_number": "480-501-0511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DARE BEHAVIORAL HEALTH AND WELLNESS CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-01",
        "last_updated": "2025-07-01",
        "certification_date": "2025-06-30",
        "status": "A",
        "authorized_official_last_name": "OLUWADARE",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-501-0511"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.